Long-term efficacy of insulin glargine therapy with an educational programme in type 1 diabetes patients in clinical practice.

OBJECTIVE: To investigate the effect of initiating insulin glargine (glargine: LANTUS), a once-daily basal insulin analogue, plus an educational programme, on glycaemic control and body weight in patients with type 1 diabetes in clinical practice. RESEARCH DESIGN AND METHODS: A retrospective analysis of the medical records of 65 patients (mean age: 40.7 +/- 13.3 years) with type 1 diabetes was performed. Patients had previously been treated with NPH insulin (NPH; n = 54) or NPH insulin + lente insulin (NPH + lente; n = 11) and then received glargine once daily (bedtime), plus short-acting prandial insulin, for 30 months. Before initiation of glargine, patients participated in a diabetes educational programme and then received physician consultations throughout the study. Metabolic control, body weight and severe hypoglycaemia data were analysed at 9 and 30 months.
RESULTS: Following initiation of glargine, patients showed a decrease in HbA(1c) from 7.29 +/- 1.1% to 7.06 +/- 1.0%; p < 0.01 at 30 months. When the results were analysed by pre-treatment, both NPH-pre-treated and NPH+lente-pre-treated patients showed a significant reduction in HbA(1c) of 0.14% and 0.82%, respectively, at 30 months (7.27 +/- 1.2% to 7.13 +/- 1.1% and 7.42 +/- 1.2 to 6.60 +/- 0.3%, respectively; p < 0.01). No change in body weight was observed in the overall group. No episodes of severe hypoglycaemia (blood glucose < 40 mg/dL [< 2.2 mmol/L] occurred.
CONCLUSIONS: In this retrospective study of medical records, patients with type 1 diabetes treated with insulin glargine over 30 months in combination with educational support and close clinical supervision decreased their HbA(1c) levels without weight gain versus previous treatment with NPH insulin or insulin lente. Further studies in a larger cohort of patients would help to confirm these results.